Patella Tendonitis : Symptoms, Causes & Treatment

What is Patella Tendonitis?

A tendon can be defined as a string that connects a bone to muscle and the term tendonitis refers to the inflammation in the tendon. Therefore, Patella tendonitis can be defined as a lesion of the tendon that connects the kneecap (patella) to the tibia. The patella tendons are responsible to work with the muscles in the front of the thigh, extending the knee, allowing a person to run, kick, and jump [1].

Patella tendonitis is commonly known as jumper’s knee, because it is mostly diagnosed among athletes who play jumping sports, such as basketball and volleyball. However, a recent study reported that some people who don’t practice jumping or sporting activity can also develop patellar tendonitis [1, 2].

Symptoms of Patella Tendonitis

Pain is the foremost sign of patellar tendonitis, at the site where the patella and tibia are joined through this tendon. However, during the initial phase of tendonitis, mild knee pain is felt only after exercising or training hard. But when the inflammation is increased over time, the pain intensifies and begins to interfere with the knee movement during sports and jumping that ultimately resulting in restricted daily activities due to worse pain in the knee especially during climbing stairs, or getting up from a chair [2].

Causes of Patella Tendonitis

Tendon Injury

Patellar tendonitis is an injury caused by overuse and repeated pressure on the patella tendon. This pressure can cause a slight tear in the ligament that results in inflammation in the tendon and the body starts the normal healing cycle to repair the tears in the tendon and to reduce inflammation. But when the ligament is continued to be injured, it can cause chronic pain due to inflammation and weakening of the tendon. When this tendon injury lasts for several weeks, it is referred to as tendinopathy [3].

Exercise

Frequent or excessive exercise, running, and jumping often involve the tear or injury in the patella tendon. This is because excessive exercise can result in a sudden increase in the intensity or frequency of exercise that ultimately increases the pressure on the tendon. It is also found that shoes during the exercise are also very important as a bad sole shoe can increase the pressure in the patellar tendon causing patellar tendonitis [4].

Tight leg muscles

The increased tension muscles in the Iliotibial band (IT Band), quadriceps, and hamstrings in the back of the thigh increase pressure on the patella tendon [3].

Muscle imbalance

If any of the leg muscles are much stronger than others in terms of their mass and volume, stronger muscles can put excess stress on the patella tendon. This irregular tension can cause inflammation of the tendons [4]. 

Chronic disease

Some conditions interfere with blood flow to the knee and weaken tendons, such as renal diseases, autoimmune diseases like lupus or rheumatoid arthritis as well as metabolic problems like diabetes [4].

Healing Cycle of Patellar Tendonitis

A normal healing cycle consists of three stages namely inflammation, proliferation, and maturation. The inflammation stage includes increased temperature, redness, swelling, and pain at the patella and the surrounding area. The proliferation stage comprises the scar tissue release at the inflamed patellar tendon to cover it so that the healing process can be continued. A trigger point release, when the scar tissue completely covers the inflamed tendon, the fascia layers are released to heal the injured or inflamed site. As the fascia is released, the healing cycle enters into the maturation stage where the scar tissue is shed off and the fascia is matured at the tendon that fully heals the tendon [5].

However, in a chronic healing cycle, the inflammation and proliferation stages are continued because of the continuous inflammation and prolonged release of the scar tissue and fascia. Therefore, it is needed to externally trigger the scar tissue and fascia release at the inflamed tendon so that it could reach the maturation stage [6].

Effective Treatment of Patellar Tendonitis

The treatment interventions for patellar tendonitis are different for each stage of the healing cycle, which are described below.

During the inflammation stage, the best cure is to take enough rest because the lesser the movement of the knee, the lesser will be the tendon stretching, and the lesser will be the inflammation. Besides this, natural ways of reducing inflammation are through consuming an anti-inflammatory diet and a diet that is rich in certain vitamins and minerals. A study suggests that restoring certain deficiencies of essential vitamins and minerals helps treat a variety of diseases including patellar tendonitis. However, Magna Heal can also be used as an externally wearable device that utilizes magnetic force to align the tendon and muscles that help in reducing the inflammation [6].

During the proliferation stage, the treatment of patellar tendonitis requires extensive scar tissue release, trigger point release, and fascia release that could be done by using an external instrument specifically designed for the therapeutic pressure application superficially so that the proliferation stage can reach the maturation stage. As the scar tissue is comprised of the superficial and deep layers, therefore the A3 tool is used to release superficial scar tissue whereas A5 is used for deeper scar tissue release. Similarly, fascia is also made up of a superficial layer and four deeper layers (aponeurotic, epimysium, perimysium, and endomysium). For superficial fascia release, A1 is specially designed to apply pressure at the pressure points whereas, for deeper layers of fascia, A5 is used for the pressure application. This helps in completing the healing cycle of the patellar tendonitis and reducing pain [7].

Therefore, it is suggested that along with the use of Magna Heal and pressure instrument use, taking rest, consuming an anti-inflammatory diet, and restoring deficiencies are necessary to treat and stop the pain of the patellar tendonitis.

 

References 

  1. Dan M, Parr W, Broe D, Cross M, Walsh WR. Biomechanics of the knee extensor mechanism and its relationship to patella tendinopathy: A review. Journal of Orthopaedic Research®. 2018 Dec;36(12):3105-12.
  2. Malliaras P, Cook J, Purdam C, Rio E. Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. journal of orthopaedic & sports physical therapy. 2015 Nov;45(11):887-98.
  3. Breda SJ, Oei EH, Zwerver J, Visser E, Waarsing E, Krestin GP, de Vos RJ. Effectiveness of progressive tendon-loading exercise therapy in patients with patellar tendinopathy: a randomised clinical trial. British journal of sports medicine. 2021 May 1;55(9):501-9.
  4. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine. 2009 Jun 1;43(6):409-16.
  5. Malliaras P, Barton CJ, Reeves ND, Langberg H. Achilles and patellar tendinopathy loading programmes. Sports medicine. 2013 Apr;43(4):267-86.
  6. Damgacı L, Özer H, Duran S. Patella–patellar tendon angle and lateral patella–tilt angle decrease patients with chondromalacia patella. Knee Surgery, Sports Traumatology, Arthroscopy. 2020 Aug;28:2715-21.
  7. Visnes H, Bahr R. The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes. British journal of sports medicine. 2007 Apr 1;41(4):217-23.